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OPINION: Spend less on costly housing projects, more on mental health

Orange County Register - 2/29/2020

Feb. 29--In 2018, the online ticketing service Eventbrite carried a listing for a Homeless Service Professionals Job Fair of Los Angeles.

"Due to the significant increase in funding from Measure H to fund homelessness services, there are over 1,000 open positions across the homeless service delivery system in the L.A. area," the listing announced. "We will have at the job fair over 40 employers from throughout the L.A. region who are hiring for these positions."

The money collected by L.A. County from the Measure H sales tax increase, about $355 million per year, funded the hiring of "senior management, executive directors, CEO/CFO/COO, and more," according to the job fair listing. Also "professional level" employees "with advanced degrees" as well as "management/supervisory level" staff with titles such as "supervisors, coordinators, program managers and directors."

In Los Angeles, that's where the tax money for homeless services is going. More than 40 "employers" receiving Measure H funds have hired more than 1,000 people.

We'd be better off if we turned the money over to the county and city fire departments. They're incurring massive costs related to medical emergency calls for people who should be in hospitals or residential treatment facilities, but instead are living on the sidewalks and freeway embankments while 1,000 other people collect salaries for taking notes on their whereabouts, or filing the notes of the employees they supervise, coordinate, manage or direct.

If anybody was reading the notes, we'd have information that could guide real solutions. Some people can be helped with short-term housing and job assistance. Others need medical care. Building supportive housing at a sky-high cost to taxpayers is not the answer for people who should be patients, not tenants.

And that brings us to an interesting item in President Trump's budget proposal. The president wants an additional $5.9 billion over 10 years in Medicaid spending for institutional services. He wants to waive a provision of the 1965 Medicaid Act known as the IMD exclusion.

IMD stands for institutions for mental diseases. The Medicaid Act offered states matching funds for their spending on mental health care in community settings. It prohibited federal reimbursement for services provided in institutions, typically inpatient facilities for the treatment of mental health and substance abuse disorders with more than 16 beds.

In the 1960s, many people who were confined to institutions could be treated successfully in outpatient facilities or community-based settings. The IMD exclusion was intended to accelerate that transition. There were unintended consequences. We're living through them right now.

Without Medicaid funding for mental health institutions, these facilities gradually closed down. And that's how we went from treating severe mental illness in hospitals to treating it with "outreach workers" who take notes and wait for the individuals to agree to accept help.

There's no limit to the amount of money California taxpayers will be asked to pay to fund non-solutions to this part of the homelessness crisis. In his State of the State address, Gov. Gavin Newsom called for new and ongoing revenue sources to pay for homeless services and housing.

"New and ongoing revenue sources" means new and higher taxes. "Homeless services and housing," in practice, means a lot of new salaries and unaffordably expensive housing construction. In Los Angeles, homeless housing built with $1.2 billion in bond funds from Measure HHH is costing as much as $700,000 per unit.

In addition to tax increases, Newsom appears to be in favor of a harsh crackdown on local governments that fail to spend money and approve housing in the manner he supports. He threatened to hold cities and counties "accountable" if they don't spend enough of their mental health funds on services for the homeless mentally ill. And he urged the Legislature to pass land-use laws that override local opposition to the construction of affordable housing projects. "I respect local control, but not at the cost of creating a two-class California," the governor said.

This is not a solution to the problem of people living in filthy tent encampments in cities throughout California, a disaster that is engulfing the state and increasingly becoming a political crisis for elected officials. A USC poll released on February 13 found that 41.5% of likely California voters said the streets and public areas where they lived had many tent encampments.

It's not enough to order cities and counties to spend mental health funds on services for the homeless mentally ill. It's not enough to build apartments for a tiny fraction of the homeless population.

We lack the physical facilities to treat people with severe or gravely disabling mental illness. Repealing the IMD exclusion and finally allowing Medicaid to pay for care in institutions for mental health treatment is a genuine solution. It's only part of the answer to the homelessness crisis. But it's a big improvement over leaving people to die on the sidewalk, then pointing at their tents to argue for state-mandated zoning and higher taxes.

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